Healthcare Provider Details

I. General information

NPI: 1053842047
Provider Name (Legal Business Name): LISA ANNETTE CRAMER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA ANNETTE PETERS APRN

II. Dates (important events)

Enumeration Date: 03/22/2017
Last Update Date: 02/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 COLLEGE BLVD
OVERLAND PARK KS
66210-6621
US

IV. Provider business mailing address

216 S DALTON DR
LONE JACK MO
64070-9617
US

V. Phone/Fax

Practice location:
  • Phone: 913-599-2440
  • Fax: 913-599-5252
Mailing address:
  • Phone: 660-890-4821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number5377595
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2017007335
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: